Pakistan has been suffering from a chronic deficit in the current account for many decades. Current account deficit strengthens the foreign currency against the home currency which makes imports of good and services m...Pakistan has been suffering from a chronic deficit in the current account for many decades. Current account deficit strengthens the foreign currency against the home currency which makes imports of good and services more expensive as compared to exports and causes devaluation of home currency. The main objective of this paper is to find out how the current account deficit is influenced by different economic factors. Our regression model’s estimated results indicate that the percentage change in the volume of imports, foreign direct investments and total consumption are positively correlated and, on the other hand, exports, workers remittance, growth in agriculture and manufacturing are negatively correlated with the current account balance of Pakistan during the observed period 1972-2001.展开更多
Since Bi2Sr2Ca1Cu2O8＋x（Bi2212） wires are subject to mechanical loadings, degradation of critical current will occur. The effect of compressive loadings on the critical current of Bi2212 wire is studied by consideri...Since Bi2Sr2Ca1Cu2O8＋x（Bi2212） wires are subject to mechanical loadings, degradation of critical current will occur. The effect of compressive loadings on the critical current of Bi2212 wire is studied by considering micro-buckling of filament. A Bi2212 wire is regarded as a unidirectional filament-reinforced composite in the theoretical analysis. By considering the influence of inclusion, the micro-buckling wavelength can be derived by using a two-dimensional model. Based on the experimental results, the critical current is fitted as a function of buckling wavelength. It is found that the decrease of the critical current is directly proportional to the reciprocal of square of the buckling wavelength. Change of micro-buckling wavelength with material parameters is discussed. A critical strain in the wire with a filament bridge is analyzed using the finite element method.展开更多
This paper investigates the mediation of the adoption of computerized accounting system （CAS） on the relationship between environmental uncertainty and organizational performance. The authors use factor analysis, pa...This paper investigates the mediation of the adoption of computerized accounting system （CAS） on the relationship between environmental uncertainty and organizational performance. The authors use factor analysis, path analysis, and regression model to examine the effects of CAS adoption on the relationship between environmental uncertainty and organizational performance. The findings reveal that the adoption level of CAS is positively associated with organizational characteristics, environmental uncertainty, and organizational performance, and the usage of CAS has a statistically significant mediating effect on the relationship between environmental uncertainty and organizational performance. This paper will be significant to business managers in the decision to adopt CAS.展开更多
The study examined the inhibitory effect of Atractylodes macrocephala （AM） on the uterine contraction during premature delivery and explored its electrophysiological mechanism by studying the effects of AM on the C...The study examined the inhibitory effect of Atractylodes macrocephala （AM） on the uterine contraction during premature delivery and explored its electrophysiological mechanism by studying the effects of AM on the Ca^2＋-activated K^＋ currents of pregnant human myometrial smooth muscle cells with or without the treatment with intedeukin-6. Single cells were acutely isolated from pregnant human myometrial smooth muscles. Whole-cell Ca^2＋-activated K^＋ currents were recorded by using an Axopatchl-D amplifier. The cells were divided into three groups： group A in which AM was added into perfusate, group B, in which interleukin-6 was added into perfusate） and group C in which AM was added into perfusate after addition of interleukin-6. IL-6 10 ng/mL inhibited BKca by 36.9%±13.7% as compared with control （P〈0.01）. AM at 2 mg/mL raised BKca by 36.7%±22.6% or 45.2%±13.7% with or without the treatment of IL-6, respectively （P〈0.01）. It is concluded that AM was able to enhance the BKca of pregnant human myometrial smooth muscle cells treated or untreated with interleukin-6 and its effect on the BKca IL-treated cells was stronger that its effect on BKca of untreated cells. Our results suggested that AM can help to maintain the membrane potentials and the resting status of pregnant human myometrial smooth muscle cells.展开更多
Background: While public municipal hospitals in Japan are supported by public financing and are less likely to fail than private hospitals, more than half are in financial deficit. Hospitals running at a deficit may h...Background: While public municipal hospitals in Japan are supported by public financing and are less likely to fail than private hospitals, more than half are in financial deficit. Hospitals running at a deficit may have poorer outcomes and less investment in maintenance of human or physical capital, as well as increased rates of patient adverse events. We sought to clarify the relationship between municipal hospital surpluses or deficits and salary expenditures. Methods: We extracted financial data for 253 general hospitals of 300 beds or more from financial statements for the 2013 fiscal year available in the Yearbook of Public Firms, Edition for Hospital. From these data, we calculated account balance ratios and compared the average value of the ratio of labor to the output (salary ratio) for each group using analysis of variance (ANOVA). Results: The salary ratios of hospitals in the surplus group were significantly lower than the salary ratios of hospitals in the deficit group (55.5% vs. 49.4%;p p = 0.342). In the surplus group, the average value of salary ratios was different among the three-bed count groups (mean salary ratio: 53.0% vs. 48.5% vs. 47.4%;ANOVA p = 0.012). In addition, there was a significant difference in mean value between the 300-bed group and ≥500 beds group (mean salary ratio: 53.0% vs. 47.4%;p = 0.002). Conclusion: This study suggests that maintaining a favorable salary ratio to the current account balance is a useful proxy of fiscal health, and interventions to improve the salary ratio may be effective in improving municipal hospital management. Furthermore, among well-managed municipal hospitals, larger hospital size may confer some advantage in purchasing power.展开更多
To determine the effects of HOE 694, a new and potent Na＋- H＋ exchanger blocker, on transient inward current (Iti) and Na＋- Ca2＋ exchange during hypoxia- reoxygenation in guinea pig cardiomyocytes. Methods. Cardio...To determine the effects of HOE 694, a new and potent Na＋- H＋ exchanger blocker, on transient inward current (Iti) and Na＋- Ca2＋ exchange during hypoxia- reoxygenation in guinea pig cardiomyocytes. Methods. Cardiomyocytes were isolated from adult guinea pig ventricle. Experiment was performed in an experimental chamber that allowed the cells to be exposed to a sufficiently low O2 pressure. The cells were subjected to hypoxia and reoxygenation. The ionic currents were studied with patch clamp technique. Results. In the absence of HOE 694, hypoxia- reoxygenation induced Iti in 12 of 15 experiments; but in cardiomyocytes pretreated with HOE 694 (10～ 50μ mol/L), the incidence of Iti observed during reoxygenation was reduced to 5 of 11 experiments and 3 of 10 experiments, P Conclusions. Blockade of the Na＋- H＋ exchange by HOE 694 could reduce Ca2＋ overload upon hypoxia- reoxygenation, and inhibition of Na＋- H＋ exchange may also indirectly decrease Na＋- Ca2＋ exchange activity during hypoxia.展开更多
Along with the unceasing expansion of the human society production and the economic activity scale, the influence and harm of the social economy to the global environment is more and more serious. As one of the high-p...Along with the unceasing expansion of the human society production and the economic activity scale, the influence and harm of the social economy to the global environment is more and more serious. As one of the high-polluting industries in China, the environment problems of the thermal power enterprises attract attention from the country and society. It is crucial for the country to improve the laws and regulations about the disclosure of environmental accounting information gradually, and the thermal power enterprises should also disclose more valuable environmental accounting information to the public. This paper analyzes and elaborates the current situation, countermeasure and implement way of the environmental accounting information disclosure systematically.展开更多
It was approved by the State Council in I984 to establish economicand technological development zones in 14 coastal port cities tofunction as windows for those cities to attract foreign investment,introduce advanced t...It was approved by the State Council in I984 to establish economicand technological development zones in 14 coastal port cities tofunction as windows for those cities to attract foreign investment,introduce advanced technology and management methods andexpand the export-oriented economy.Since 1992,18 other developmentzones have been approved by the Council,increasing the number ofsuch zones to 32.展开更多
Aims T-type Ca<sup>2+</sup> current(I<sub>CaT</sub>)plays an important role in the pathogenesis of atrial fibrillation（AF）.The present study sought to investigate the role of Macrophage migra...Aims T-type Ca<sup>2+</sup> current(I<sub>CaT</sub>)plays an important role in the pathogenesis of atrial fibrillation（AF）.The present study sought to investigate the role of Macrophage migration inhibitory factor（MIF）,a pleiotropic cytokine,in the regulation of T-type Ca<sup>2+</sup> channel in atrium myocytes.Methods We used whole-cell voltage-clamp technique and biochemical assays to study the regulation and expression of I<sub>Ca</sub>,T in mouse atrium myocytes（HL-1 cells）.Results Serum MIF concentrations was slightly increased in patients with AF compared to sinus rhythm（SR） controls.In cultured HL-1 cells, significant amounts of MIF were produced in response to hydrogen peroxide（H<sub>2</sub>O<sub>2</sub>）,but not AngiotensinⅡ（AngⅡ）. Mouse recombinant MIF（rMIF）（20 or 40 nM,24 h） suppressed peak ICa,T by-38%and-60%in a concentration-dependent manner,impaired the voltage-dependent activation of I<sub>Ca</sub>,T,and down-regulated of TCC alG mRNA.Src inhibitors genistein and PPl significantly enhanced ICaT.The depression of ICa,T induced by rMIF could be reversed by genistein and PP1.Conclusions MIFis involved in the pathogenesis of AF,probably by decreasing ICa,T through impairment of the channel function and activation of c-Src kinases in atrium myocytes.展开更多
Objectives To investigate effect of Angll, captopril on single guinea myocytes on L - type calcium current and sodium current. Methods Membrane patch clamp whole cell recording technique was used to investigate effect...Objectives To investigate effect of Angll, captopril on single guinea myocytes on L - type calcium current and sodium current. Methods Membrane patch clamp whole cell recording technique was used to investigate effect of angll, captopril on L - Ca maximum current density and sodium maximum current density. Resutls Angll increased the maximum current density compared with control after perfused 5 min, 357. 7 ±219. 7 Vs 279. 5± 240. 5 PA/PF, increase rate is 27. 9 %, the shape of current - voltage relationship curve was unchanged, peaked at + 10 mv, indicated that angll increased L - Ca current density in voltage - dependent. After perfused with captopril, captopril + angll 3, 5 min, L - Ca current was recorded, results suggest L - Ca maximum current density decreased significantly compared with control, in captopril group, 128. 4 ± 92. 6Vs286. 2 ± 89. 7, 66. 7±68. 3Vs 286. 2 ± 89. 7, respectively, rate of inhibition is 55. 1 %, 76. 6 %, respectively. L - Ca current further decreased in captopril perfused 5 min compared with 3 min, 66. 7 ± 68. 3 Vs 128. 4 ± 92. 6, in captopril + angll group, L - Ca current decreased greatly in 3, 5 min than control, 143. 4±117. 6Vs 267. 7±141. 4, 96. 4±82. 5 Vs 267. 7±141. 4, respectively, rate of inhibition is 46. 4 % , 63. 9 % respectively. We also investigated effect of captopril on Na current, which decreased significantly in 1 min and 3 min compared with control, 939. 1 ±319. 1 Vs 1398. 0±144. 6 PA/PF, 469. 95 ± 314. 9 Vs 1398. 0 ±144. 6 PA/PF, respectively, rate of inhibition is 32. 8 % , 66. 3 % , respectively. Na current density decreased significantly in 3 min compared with 1 min, 469. 9±314. 9 Vs 939. 1±319. 1PA/PF, rate of inhibition is 49. 9 % . Conclusions Angiotensin Ⅱexerts increased maximum current density of L - Ca in voltage dependent, captopril decreased maximum current density of L - Ca in voltage dependent, decreased sodium maximum current density, which is the prominently antiarrhythmia mechanisms through inhibition of angiotensin Ⅱ evoked calcium dependent transient inward current and calcium overload.展开更多
Since its founding in 1949, the CAS has been in duty bound to settle key S&T problems posed during national economic and defense construction,and has devoted itself to the renewal of China’s traditional industry ...Since its founding in 1949, the CAS has been in duty bound to settle key S&T problems posed during national economic and defense construction,and has devoted itself to the renewal of China’s traditional industry and the development of new technology.In June 1950, the State authorities stipulated that the main tasks for the CAS were "to cultivate versatile S&T workers and a competent work force for national construction, striving to draw close the ties between academic research and actual demands so that science can really serve the country’s industry, agriculture, national defense,展开更多
The emergence of Accountable Care Organizations(ACOs)in the landscape of the U.S.healthcare system marks a paradigm shift in healthcare operations.The potential impact of ACOs has been a topic of intense debate.Tradit...The emergence of Accountable Care Organizations(ACOs)in the landscape of the U.S.healthcare system marks a paradigm shift in healthcare operations.The potential impact of ACOs has been a topic of intense debate.Traditional analytical approaches do not lend themselves to examining the complex phenomenon of the emergence and growth of ACOs in the healthcare network.We adopt a complex adaptive system lens to examine the growth of ACOs among physician groups and explore factors that influence this growth.We also discuss the impact of ACOs on the profit of physician groups.An agent-based model was built to simulate physician groups'ACO entrance and exit based on a set of simple rules and their complex interactions with other agents.Based on the simulation results,we derive patterns of ACO expansion and contraction,following four stages of wait-and-see,rollercoaster,fast growth,and stabilizing.Findings suggest that the growth of ACOs is sensitive to the initial state of ACO membership.When the initial size of ACO membership increases,it helps to eliminate the rollercoaster stage.In addition,the growth of the ACO varies depending on the cost–quality tradeoff.When both cost and quality objectives can be met simultaneously,the growth of ACO membership follows wait-and-see and fast growth stages followed by a different stage that we term sticky state.The impact of ACOs on physician groups’cumulative profit varies by the service quality level of the physician group.Physician groups affiliated with insurance companies charging the lowest or the highest level of health insurance premiums are worse off with the ACO option.However,the ACO benefits physician groups affiliated with an insurance company charging a moderate level of premiums.展开更多
基金Sponsored by the National Center of Technology, Policy and Management, Harbin Institute of Technology.
文摘Pakistan has been suffering from a chronic deficit in the current account for many decades. Current account deficit strengthens the foreign currency against the home currency which makes imports of good and services more expensive as compared to exports and causes devaluation of home currency. The main objective of this paper is to find out how the current account deficit is influenced by different economic factors. Our regression model’s estimated results indicate that the percentage change in the volume of imports, foreign direct investments and total consumption are positively correlated and, on the other hand, exports, workers remittance, growth in agriculture and manufacturing are negatively correlated with the current account balance of Pakistan during the observed period 1972-2001.
基金Project supported by the National Natural Science Foundation of China(Nos.11327802,11472120,and 11421062)the National Key Project of Magneto-Constrained Fusion Energy Development Program(No.2013GB110002)the Fundamental Research Funds for the Central Universities(No.lzujbky-2017-k18)
文摘Since Bi2Sr2Ca1Cu2O8＋x（Bi2212） wires are subject to mechanical loadings, degradation of critical current will occur. The effect of compressive loadings on the critical current of Bi2212 wire is studied by considering micro-buckling of filament. A Bi2212 wire is regarded as a unidirectional filament-reinforced composite in the theoretical analysis. By considering the influence of inclusion, the micro-buckling wavelength can be derived by using a two-dimensional model. Based on the experimental results, the critical current is fitted as a function of buckling wavelength. It is found that the decrease of the critical current is directly proportional to the reciprocal of square of the buckling wavelength. Change of micro-buckling wavelength with material parameters is discussed. A critical strain in the wire with a filament bridge is analyzed using the finite element method.
文摘This paper investigates the mediation of the adoption of computerized accounting system （CAS） on the relationship between environmental uncertainty and organizational performance. The authors use factor analysis, path analysis, and regression model to examine the effects of CAS adoption on the relationship between environmental uncertainty and organizational performance. The findings reveal that the adoption level of CAS is positively associated with organizational characteristics, environmental uncertainty, and organizational performance, and the usage of CAS has a statistically significant mediating effect on the relationship between environmental uncertainty and organizational performance. This paper will be significant to business managers in the decision to adopt CAS.
文摘The study examined the inhibitory effect of Atractylodes macrocephala （AM） on the uterine contraction during premature delivery and explored its electrophysiological mechanism by studying the effects of AM on the Ca^2＋-activated K^＋ currents of pregnant human myometrial smooth muscle cells with or without the treatment with intedeukin-6. Single cells were acutely isolated from pregnant human myometrial smooth muscles. Whole-cell Ca^2＋-activated K^＋ currents were recorded by using an Axopatchl-D amplifier. The cells were divided into three groups： group A in which AM was added into perfusate, group B, in which interleukin-6 was added into perfusate） and group C in which AM was added into perfusate after addition of interleukin-6. IL-6 10 ng/mL inhibited BKca by 36.9%±13.7% as compared with control （P〈0.01）. AM at 2 mg/mL raised BKca by 36.7%±22.6% or 45.2%±13.7% with or without the treatment of IL-6, respectively （P〈0.01）. It is concluded that AM was able to enhance the BKca of pregnant human myometrial smooth muscle cells treated or untreated with interleukin-6 and its effect on the BKca IL-treated cells was stronger that its effect on BKca of untreated cells. Our results suggested that AM can help to maintain the membrane potentials and the resting status of pregnant human myometrial smooth muscle cells.
文摘Background: While public municipal hospitals in Japan are supported by public financing and are less likely to fail than private hospitals, more than half are in financial deficit. Hospitals running at a deficit may have poorer outcomes and less investment in maintenance of human or physical capital, as well as increased rates of patient adverse events. We sought to clarify the relationship between municipal hospital surpluses or deficits and salary expenditures. Methods: We extracted financial data for 253 general hospitals of 300 beds or more from financial statements for the 2013 fiscal year available in the Yearbook of Public Firms, Edition for Hospital. From these data, we calculated account balance ratios and compared the average value of the ratio of labor to the output (salary ratio) for each group using analysis of variance (ANOVA). Results: The salary ratios of hospitals in the surplus group were significantly lower than the salary ratios of hospitals in the deficit group (55.5% vs. 49.4%;p p = 0.342). In the surplus group, the average value of salary ratios was different among the three-bed count groups (mean salary ratio: 53.0% vs. 48.5% vs. 47.4%;ANOVA p = 0.012). In addition, there was a significant difference in mean value between the 300-bed group and ≥500 beds group (mean salary ratio: 53.0% vs. 47.4%;p = 0.002). Conclusion: This study suggests that maintaining a favorable salary ratio to the current account balance is a useful proxy of fiscal health, and interventions to improve the salary ratio may be effective in improving municipal hospital management. Furthermore, among well-managed municipal hospitals, larger hospital size may confer some advantage in purchasing power.
基金This work was supported by Leading Specialty Funding of Shanghai, Grant No.94- III- 001.
文摘To determine the effects of HOE 694, a new and potent Na＋- H＋ exchanger blocker, on transient inward current (Iti) and Na＋- Ca2＋ exchange during hypoxia- reoxygenation in guinea pig cardiomyocytes. Methods. Cardiomyocytes were isolated from adult guinea pig ventricle. Experiment was performed in an experimental chamber that allowed the cells to be exposed to a sufficiently low O2 pressure. The cells were subjected to hypoxia and reoxygenation. The ionic currents were studied with patch clamp technique. Results. In the absence of HOE 694, hypoxia- reoxygenation induced Iti in 12 of 15 experiments; but in cardiomyocytes pretreated with HOE 694 (10～ 50μ mol/L), the incidence of Iti observed during reoxygenation was reduced to 5 of 11 experiments and 3 of 10 experiments, P Conclusions. Blockade of the Na＋- H＋ exchange by HOE 694 could reduce Ca2＋ overload upon hypoxia- reoxygenation, and inhibition of Na＋- H＋ exchange may also indirectly decrease Na＋- Ca2＋ exchange activity during hypoxia.
文摘Along with the unceasing expansion of the human society production and the economic activity scale, the influence and harm of the social economy to the global environment is more and more serious. As one of the high-polluting industries in China, the environment problems of the thermal power enterprises attract attention from the country and society. It is crucial for the country to improve the laws and regulations about the disclosure of environmental accounting information gradually, and the thermal power enterprises should also disclose more valuable environmental accounting information to the public. This paper analyzes and elaborates the current situation, countermeasure and implement way of the environmental accounting information disclosure systematically.
文摘It was approved by the State Council in I984 to establish economicand technological development zones in 14 coastal port cities tofunction as windows for those cities to attract foreign investment,introduce advanced technology and management methods andexpand the export-oriented economy.Since 1992,18 other developmentzones have been approved by the Council,increasing the number ofsuch zones to 32.
文摘Aims T-type Ca<sup>2+</sup> current(I<sub>CaT</sub>)plays an important role in the pathogenesis of atrial fibrillation（AF）.The present study sought to investigate the role of Macrophage migration inhibitory factor（MIF）,a pleiotropic cytokine,in the regulation of T-type Ca<sup>2+</sup> channel in atrium myocytes.Methods We used whole-cell voltage-clamp technique and biochemical assays to study the regulation and expression of I<sub>Ca</sub>,T in mouse atrium myocytes（HL-1 cells）.Results Serum MIF concentrations was slightly increased in patients with AF compared to sinus rhythm（SR） controls.In cultured HL-1 cells, significant amounts of MIF were produced in response to hydrogen peroxide（H<sub>2</sub>O<sub>2</sub>）,but not AngiotensinⅡ（AngⅡ）. Mouse recombinant MIF（rMIF）（20 or 40 nM,24 h） suppressed peak ICa,T by-38%and-60%in a concentration-dependent manner,impaired the voltage-dependent activation of I<sub>Ca</sub>,T,and down-regulated of TCC alG mRNA.Src inhibitors genistein and PPl significantly enhanced ICaT.The depression of ICa,T induced by rMIF could be reversed by genistein and PP1.Conclusions MIFis involved in the pathogenesis of AF,probably by decreasing ICa,T through impairment of the channel function and activation of c-Src kinases in atrium myocytes.
文摘Objectives To investigate effect of Angll, captopril on single guinea myocytes on L - type calcium current and sodium current. Methods Membrane patch clamp whole cell recording technique was used to investigate effect of angll, captopril on L - Ca maximum current density and sodium maximum current density. Resutls Angll increased the maximum current density compared with control after perfused 5 min, 357. 7 ±219. 7 Vs 279. 5± 240. 5 PA/PF, increase rate is 27. 9 %, the shape of current - voltage relationship curve was unchanged, peaked at + 10 mv, indicated that angll increased L - Ca current density in voltage - dependent. After perfused with captopril, captopril + angll 3, 5 min, L - Ca current was recorded, results suggest L - Ca maximum current density decreased significantly compared with control, in captopril group, 128. 4 ± 92. 6Vs286. 2 ± 89. 7, 66. 7±68. 3Vs 286. 2 ± 89. 7, respectively, rate of inhibition is 55. 1 %, 76. 6 %, respectively. L - Ca current further decreased in captopril perfused 5 min compared with 3 min, 66. 7 ± 68. 3 Vs 128. 4 ± 92. 6, in captopril + angll group, L - Ca current decreased greatly in 3, 5 min than control, 143. 4±117. 6Vs 267. 7±141. 4, 96. 4±82. 5 Vs 267. 7±141. 4, respectively, rate of inhibition is 46. 4 % , 63. 9 % respectively. We also investigated effect of captopril on Na current, which decreased significantly in 1 min and 3 min compared with control, 939. 1 ±319. 1 Vs 1398. 0±144. 6 PA/PF, 469. 95 ± 314. 9 Vs 1398. 0 ±144. 6 PA/PF, respectively, rate of inhibition is 32. 8 % , 66. 3 % , respectively. Na current density decreased significantly in 3 min compared with 1 min, 469. 9±314. 9 Vs 939. 1±319. 1PA/PF, rate of inhibition is 49. 9 % . Conclusions Angiotensin Ⅱexerts increased maximum current density of L - Ca in voltage dependent, captopril decreased maximum current density of L - Ca in voltage dependent, decreased sodium maximum current density, which is the prominently antiarrhythmia mechanisms through inhibition of angiotensin Ⅱ evoked calcium dependent transient inward current and calcium overload.
文摘Since its founding in 1949, the CAS has been in duty bound to settle key S&T problems posed during national economic and defense construction,and has devoted itself to the renewal of China’s traditional industry and the development of new technology.In June 1950, the State authorities stipulated that the main tasks for the CAS were "to cultivate versatile S&T workers and a competent work force for national construction, striving to draw close the ties between academic research and actual demands so that science can really serve the country’s industry, agriculture, national defense,
文摘The emergence of Accountable Care Organizations(ACOs)in the landscape of the U.S.healthcare system marks a paradigm shift in healthcare operations.The potential impact of ACOs has been a topic of intense debate.Traditional analytical approaches do not lend themselves to examining the complex phenomenon of the emergence and growth of ACOs in the healthcare network.We adopt a complex adaptive system lens to examine the growth of ACOs among physician groups and explore factors that influence this growth.We also discuss the impact of ACOs on the profit of physician groups.An agent-based model was built to simulate physician groups'ACO entrance and exit based on a set of simple rules and their complex interactions with other agents.Based on the simulation results,we derive patterns of ACO expansion and contraction,following four stages of wait-and-see,rollercoaster,fast growth,and stabilizing.Findings suggest that the growth of ACOs is sensitive to the initial state of ACO membership.When the initial size of ACO membership increases,it helps to eliminate the rollercoaster stage.In addition,the growth of the ACO varies depending on the cost–quality tradeoff.When both cost and quality objectives can be met simultaneously,the growth of ACO membership follows wait-and-see and fast growth stages followed by a different stage that we term sticky state.The impact of ACOs on physician groups’cumulative profit varies by the service quality level of the physician group.Physician groups affiliated with insurance companies charging the lowest or the highest level of health insurance premiums are worse off with the ACO option.However,the ACO benefits physician groups affiliated with an insurance company charging a moderate level of premiums.
